New Orleans: Laissez le Bons Temps Rouler!

Commonly associated with the debauchery and decadence of Mardi Gras, New Orleans is a city occupying a unique place in American history. Its racial and cultural makeup speaks to African, French, and Spanish influences during its colonization, and its socioeconomic disparities reflect a legacy of slavery and racism. Recovering from Hurricane Katrina has not been easy for this city, and its difficult path to reconstruction has been hampered by the city’s long-standing social and economic inequities. Of note is the city’s fight against HIV/AIDS: New Orleans is the metropolitan area with the 3rd largest HIV/AIDS case rate in the US.[1] At the forefront are community organizations like NO/AIDS Task Force, which emerged in the early 1980s to tackle the rapidly advancing AIDS epidemic in the region. During the summer of 2013, I interned at NO/AIDS Task Force, in the organization’s Community Awareness Network Office. As an intern, I partook in its efforts against an epidemic that continues to silently ravage our nation’s most marginalized communities.

My internship began with rapid-HIV-testing training, a month-long process that prepared me for Louisiana’s HIV tester certification.[2] One of my formative experiences during that first month was sitting in training seminars with a diverse group of people­–from health care providers to graduate students to social workers–all were taking part in their state’s battle against the HIV epidemic.

Meanwhile, I continued working at the organization’s satellite office on Frenchman Street, where I performed tasks like creating promotional materials for the organization’s youth services, calling our clients about additional sexual health resources, and managing the front desk during our syringe access hours. I was exposed not only to the wide-ranging work that goes on in the public health and nonprofit sectors, but also to the diverse communities that made up our clientele.

When I finally obtained my certification, my internship shifted toward HIV testing. Because it was critical that the organization reach out to at-risk communities, I was sent to places like gay clubs and bathhouses. There, I would work with a partner to test any and all interested parties. It was intimidating at first: there I was, speaking about “risk factors” and offering to demonstrate proper condom use to the people who were living in one of the epicenters of our nation’s HIV epidemic. Most people were polite and kind, declining to confront my naiveté or test my knowledge as only a patient and friendly Southerner could.

Sometimes, I would meet with a patient who knew very little about the testing process or about safer sex methods. It was here where I realized how health inequities take on multiple forms, besides inaccessibility to medicine, or lack of health insurance. On more than one occasion I met with a young queer person, unclear about the urban myths about HIV. Whereas I received a comprehensive (and often graphic) sexual health education in high school, I realized that there were many Louisianans that did not.

On one occasion, I was asked to volunteer my testing skills at an outreach event geared toward New Orleans’ growing Latino population. I met people from immigrant backgrounds not unlike mine. I realized how much public health efforts still have to go in accessing marginalized communities. Many had never had an HIV test, or perhaps had only heard of safer sex in passing. Speaking as best as I could in a Spanish not practiced in months, I relayed as much information as I could, provided all the condoms that were allowed, and had conversations with a familiar community. It was through HIV testing that I realized the work that remains to be done in communities of color, and in impoverished communities. New Orleans confirmed to me how much more expansive the scope of inequality is in our country. It is most often the communities that are already facing discrimination and impoverishment that are disproportionately pushed into the crosshairs of the HIV epidemic.

Fast forward to December 2013: an article popped up on my Facebook feed, alarmingly alerting me to “Human Rights violations in New Orleans.” I clicked and found a Human Rights Report confirming what my coworkers at NO/AIDS relayed to me months earlier. The very act of possessing a condom can be seen as a transgression. The Human Rights Report claims that sex workers are being searched and if found with a condom, can be found guilty of solicitation, among other crimes.[3] Trans individuals are especially harassed by a police force that calls them “things,” and presumes their guilt.[4] I almost couldn’t believe it when coworkers initially informed me that merely giving a condom to a person in a car during one of New Orleans’ many festivals could be construed as solicitation by the local police force. In addition to racial and economic disparities, New Orleans is dealing with a judicial and legal system that implicitly posits safe sex as an illegal act. To understand the city’s HIV/AIDS crisis is to understand a linked network of injustices that have contributed to this city’s suffering.

While one may be inclined to blame the people of New Orleans for the fractured and corrupt state of their local governmental institutions, I choose to believe instead in the power of systemic violence.[5] Centuries of inequality and discrimination in the state of Louisiana have aggravated its HIV crisis. There is only so much that organizations like NO/AIDS can do in the face of retrograde policies on the part of elected officials. This fact was reinforced during my internship: the 2013 federal sequester forced our organization to put off on hiring an additional staff person.

In the meantime, community organizations like NO/AIDS continue to race against time, and with limited funding, to ensure that they reach as much of the people as they can. The battle against AIDS will involve far more than the time and energy of our community organizations and public health workers, however. Tackling HIV will require the committed work of legislators and policy makers in fixing other aspects of deeply unjust institutions. We must come together to pressure our governments – at all levels – to recognize people’s access to health care and medicine as a human right. The failure of governments to provide for this right is intimately tied to other forms of injustice. The HIV/AIDS epidemic and the blow it has dealt marginalized communities are consequences of government neglect, racial inequity, and economic marginalization.

While we must recognize the committed work of private and non-governmental actors, we must also be willing to recognize the role that the state can play in defeating epidemics. As advocates for the health of all humans, our struggle to end global health inequities will require us to demand and craft policy that confronts destructive economic systems, entrenched racism, and regressive ideas about sexuality. The story of New Orleanians, continually surviving and reconstructing in the face of devastation, provides us with a powerful example of resilience.

[5] A theory espoused by Partners in Health founder, Paul Farmer, which posits that systems of oppression interface with and amplify illness and death in impoverished communities. Thus, neglect on the part of the state and of non-governmental actors is a form of violence inflicted upon the poor.